First Person: Weiging The Risks and Rewards of Vaginal Birth After C-Section

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I respect the thought and research this author has put into her decision, rather than just blindly signing up for her next (scheduled) c-section. I lament the fact that she was induced before term and sectioned for FTP during her first delivery, but I don't know all of the facts surrounding that decision, so I will try to suspend judgement.
If you take a hard look at the data, most studies reveal that the risk of true uterine rupture in patients attempting a VBAC is less than 1%--actually closer to 0.5%, or 1 in 200, and perinatal injury or death occurs in about 10% of those ruptures. Tragic, to be sure, but that pushes the actual risk to the baby down to 1 in 2000. The much higher 1% number comes from "classical" incisions (vertical), not low horizontal incisions (most common). I hope this author can get access to better data so she can make a decision not based on fear, but fact.
We all have our own ingrained "tolerance of risk"--this risk tolerance is developed from our life experiences, genetics, upbringing, religious/philosophical views, and education. It shapes every decision we make in our lives, and makes us unique--it serves invaluable to our survival, and places us each in our own "niche" in this universe. Far be it from anyone to judge another person's risk tolerance. I feel compelled only to present facts and let the chips fall where they may.
Mark B. Landon et al., "Risk of Uterine Rupture with a Trial of Labor in Women with Multiple and Single Prior Cesarean Delivery," Obstetrics & Gynecology 108, no.1 (2006): 12-20.

M. Lydon-Rochelle et al., "Risk of Uterine Rupture during Labor among Women with a Prior Cesarean Delivery," New England Journal of Medicine 345, no.1 (2001): 3-8.
I think the point is that the risk of uterine rupture is less than 1%. Anyone who thinks that a C-section is as safe as vaginal birth isn't reading the current scholarly research on this issue. A woman is around 80% more likely to wind up with a dead baby after a why discuss vaginal birth and C-sections as if they're equal? They're not. Both mom and baby recover much better after a vaginal delivery (not to mention that mom is more likely to be dead after a Csection than a vaginal deliver according to the latest research).

In my view, the real issue with this author's take is that she's either completely unaware or completely eliding the research regarding the "safety" of C-sections. I believe a key reason women are more likely to do repeat C-sections is because doctor's have "whitewashed," this issue, making it appear that a C-section delivery and vaginal deliver are equally as safe for mom and baby...this is why women get coerced into another C-section because - of course! - that 1% risk of uterine rupture is worse than ANYTHING that could happen under a surgeon's scalpel. Those of us who follow the research know that this medicalized approach and the myths associated with it are problematical, to say the least...

Not to mention: for those who try for a VBAC and end up with a C-section, one wonders if the psychological pressure of knowing that you've had a C-section before and that there are risks associated with VBAC (as with any method, natural or not) is a significant part of why the success rate is around 75%. Not because it's not possible, but all this - coupled with a hostile healthcare provider who is terrified you'll be that 1% who ends up with uterine rupture - is enough for any little thing to become justification for a repeat C-section.
When I read this article a few points came to mind.

First, I wonder how much understanding the author has of the labor process and how her body was designed to work. She states 2 or 3 times that 60-80% of VBACs end in a repeat cesarean, but fails to address the situation that most moms attempting a VBAC find themselves in. IF a woman's doctor will let her attempt one it is explicitly clear from the beginning that she is expected to preform a certain way, within a certain time frame, or it's back to the OR. This kind of pressure does not a stress free environment make, and as many of us know, being mammalian means our bodies respond a certain way to stress in labor, by stalling. Further more, regardless of why she was induced, it doesn't change the fact that most likely, the induction failed because her body wasn't ready to be in labor, not because it was incapable.

Second, why did she not give the same statistical data when it came to risk of harm to her or the baby with a cesarean? I agree that risk is a factor in both decisions, but isn't the process of weighing risk vs benefit defeated without all the facts?



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